Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been ...determined.
To determine whether indwelling pleural catheters (IPCs) are more effective than chest tube and talc slurry pleurodesis (talc) at relieving dyspnea.
Unblinded randomized controlled trial (Second Therapeutic Intervention in Malignant Effusion Trial TIME2) comparing IPC and talc (1:1) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated at 7 UK hospitals. Patients were screened from April 2007-February 2011 and were followed up for a year.
Indwelling pleural catheters were inserted on an outpatient basis, followed by initial large volume drainage, education, and subsequent home drainage. The talc group were admitted for chest tube insertion and talc for slurry pleurodesis.
Patients completed daily 100-mm line visual analog scale (VAS) of dyspnea over 42 days after undergoing the intervention (0 mm represents no dyspnea and 100 mm represents maximum dyspnea; 10 mm represents minimum clinically significant difference). Mean difference was analyzed using a mixed-effects linear regression model adjusted for minimization variables.
Dyspnea improved in both groups, with no significant difference in the first 42 days with a mean VAS dyspnea score of 24.7 in the IPC group (95% CI, 19.3-30.1 mm) and 24.4 mm (95% CI, 19.4-29.4 mm) in the talc group, with a difference of 0.16 mm (95% CI, −6.82 to 7.15; P = .96). There was a statistically significant improvement in dyspnea in the IPC group at 6 months, with a mean difference in VAS score between the IPC group and the talc group of −14.0 mm (95% CI, −25.2 to −2.8 mm; P = .01). Length of initial hospitalization was significantly shorter in the IPC group with a median of 0 days (interquartile range IQR, 0-1 day) and 4 days (IQR, 2-6 days) for the talc group, with a difference of −3.5 days (95% CI, −4.8 to −1.5 days; P < .001). There was no significant difference in quality of life. Twelve patients (22%) in the talc group required further pleural procedures compared with 3 (6%) in the IPC group (odds ratio OR, 0.21; 95% CI, 0.04-0.86; P = .03). Twenty-one of the 52 patients in the catheter group experienced adverse events vs 7 of 54 in the talc group (OR, 4.70; 95% CI, 1.75-12.60; P = .002).
Among patients with malignant pleural effusion and no previous pleurodesis, there was no significant difference between IPCs and talc pleurodesis at relieving patient-reported dyspnea.
isrctn.org Identifier: ISRCTN87514420.
The metal organic framework UiO-66-NH2 has been post-synthetically modified to introduce thiourea, isothiocyanate and isocyanate functionalities without compromising the structural and thermal ...stability of the parent framework. 1H NMR and IR spectroscopies have been used to monitor the extent of framework functionalization. UiO-66, UiO-66-NH2 and the new functionalized frameworks UiO-66-NHC(S)NHMe, UiO-66-NHC(S)NHPh, UiO-66-NCS and UiO-66-NCO have been studied as adsorbents for the capture of a range of heavy metals from homoionic aqueous solution, with a view towards applications in environmental remediation. Functionalization markedly improved metal removal efficiency up to 99% with calculated maximum adsorption capacities of 49, 117, 232 and 769 mg/g for Cd2+, Cr3+, Pb2+ and Hg2+ respectively for UiO-66-NHC(S)NHMe.
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•Novel functionalised Zr-based MOFs prepared using post-synthetic modification.•Pendant sulphur-containing groups have been introduced into the pores of the MOFs.•Functionalization markedly improved heavy metal removal efficiency.•High performance material with facile preparative route and good aqueous stability.
Slowly clearing infections in the pleural space are a source of substantial morbidity. This study showed that instillation of recombinant DNase and tissue plasminogen activator (t-PA) is more ...effective than placebo in clearing radiographic pleural effusions.
Pleural infection affects more than 65,000 patients each year in the United States and the United Kingdom,
1
and the incidence is increasing in both countries — in both children
2
–
4
and adults.
5
,
6
The mortality rate from pleural infection is between 10% and 20%,
5
,
7
–
9
and drainage through a chest tube and administration of antibiotics fail in approximately one third of patients, who then require surgical drainage.
5
,
9
The median duration of the hospital stay for these patients is 12 to 15 days,
5
,
6
,
8
,
9
with 25% hospitalized for more than a month. Care of each patient costs . . .
In this randomized trial involving 454 patients with pleural infections that required antibiotic therapy and chest-tube drainage, there was no benefit from the use of intrapleural streptokinase in ...terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.
In this trial involving 454 patients with pleural infections, there was no benefit from the use of intrapleural streptokinase in terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.
Pleural infection develops in about 65,000 patients each year in the United States and the United Kingdom.
1
Approximately 15 percent of patients die,
2
which is similar to the death rate among patients hospitalized with pneumonia,
3
,
4
and 15 to 40 percent require surgical drainage of the infected pleural space.
2
,
5
The median duration of inpatient care is 15 days, with 20 percent of patients remaining in the hospital for a month or longer.
2
Apart from antibiotic therapy, treatment in patients with pleural infection consists mainly of drainage of the infected pleural fluid, and the intrapleural administration of fibrinolytic drugs is . . .
A collection of novel, pharmaceutically relevant cubane-containing molecules has been prepared from the commercially available cubane-1,4-dimethylester. A range of synthetic methods have been ...applied to prepare these cubane building blocks with one or two functional handles to allow easy incorporation into existing medicinal chemistry programs.
Twelve years of SAMtools and BCFtools Danecek, Petr; Bonfield, James K; Liddle, Jennifer ...
Gigascience,
02/2021, Letnik:
10, Številka:
2
Journal Article
Recenzirano
Odprti dostop
SAMtools and BCFtools are widely used programs for processing and analysing high-throughput sequencing data. They include tools for file format conversion and manipulation, sorting, querying, ...statistics, variant calling, and effect analysis amongst other methods.
The first version appeared online 12 years ago and has been maintained and further developed ever since, with many new features and improvements added over the years. The SAMtools and BCFtools packages represent a unique collection of tools that have been used in numerous other software projects and countless genomic pipelines.
Both SAMtools and BCFtools are freely available on GitHub under the permissive MIT licence, free for both non-commercial and commercial use. Both packages have been installed >1 million times via Bioconda. The source code and documentation are available from https://www.htslib.org.
IMPORTANCE: For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less ...painful than larger tubes, but efficacy in pleurodesis has not been proven. OBJECTIVE: To assess the effect of chest tube size and analgesia (NSAIDs vs opiates) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion. DESIGN, SETTING, AND PARTICIPANTS: A 2×2 factorial phase 3 randomized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013. INTERVENTIONS: Patients undergoing thoracoscopy (n = 206; clinical decision if biopsy was required) received a 24F chest tube and were randomized to receive opiates (n = 103) vs NSAIDs (n = 103), and those not undergoing thoracoscopy (n = 114) were randomized to 1 of 4 groups (24F chest tube and opioids n = 28; 24F chest tube and NSAIDs n = 29; 12F chest tube and opioids n = 29; or 12F chest tube and NSAIDs n = 28). MAIN OUTCOMES AND MEASURES: Pain while chest tube was in place (0- to 100-mm visual analog scale VAS 4 times/d; superiority comparison) and pleurodesis efficacy at 3 months (failure defined as need for further pleural intervention; noninferiority comparison; margin, 15%). RESULTS: Pain scores in the opiate group (n = 150) vs the NSAID group (n = 144) were not significantly different (mean VAS score, 23.8 mm vs 22.1 mm; adjusted difference, −1.5 mm; 95% CI, −5.0 to 2.0 mm; P = .40), but the NSAID group required more rescue analgesia (26.3% vs 38.1%; rate ratio, 2.1; 95% CI, 1.3-3.4; P = .003). Pleurodesis failure occurred in 30 patients (20%) in the opiate group and 33 (23%) in the NSAID group, meeting criteria for noninferiority (difference, −3%; 1-sided 95% CI, −10% to ∞; P = .004 for noninferiority). Pain scores were lower among patients in the 12F chest tube group (n = 54) vs the 24F group (n = 56) (mean VAS score, 22.0 mm vs 26.8 mm; adjusted difference, −6.0 mm; 95% CI, −11.7 to −0.2 mm; P = .04) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure (30% vs 24%), failing to meet noninferiority criteria (difference, −6%; 1-sided 95% CI, −20% to ∞; P = .14 for noninferiority). Complications during chest tube insertion occurred more commonly with 12F tubes (14% vs 24%; odds ratio, 1.91; P = .20). CONCLUSIONS AND RELEVANCE: Use of NSAIDs vs opiates resulted in no significant difference in pain scores but was associated with more rescue medication. NSAID use resulted in noninferior rates of pleurodesis efficacy at 3 months. Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinically modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN33288337
Background: The optimal choice of chest tube size for the treatment of pleural infection is unknown, with only small cohort studies reported
describing the efficacy and adverse events of different ...tube sizes.
Methods: A total of 405 patients with pleural infection were prospectively enrolled into a multicenter study investigating the utility
of fibrinolytic therapy. The combined frequency of death and surgery, and secondary outcomes (hospital stay, change in chest
radiograph, and lung function at 3 months) were compared in patients receiving chest tubes of differing size (Ï 2 , t test, and logistic regression analyses as appropriate). Pain was studied in detail in 128 patients.
Results: There was no significant difference in the frequency with which patients either died or required thoracic surgery in patients
receiving chest tubes of varying sizes ( < 10F, number dying or needing surgery 21/58 36%; size 10-14F, 75/208 36%; size
15-20F, 28/70 40%; size > 20F, 30/69 44%; Ï 2 trend, 1 degrees of freedom df = 1.21, P = .27), nor any difference in any secondary outcome. Pain scores were substantially higher in patients receiving (mainly
blunt dissection inserted) larger tubes ( < 10F, median pain score 6 range 4-7; 10-14F, 5 4-6; 15-20F, 6 5-7; > 20F,
6 6-8; Ï 2 , 3 df = 10.80, P = .013, Kruskal-Wallis; Ï 2 trend, 1 df = 6.3, P = .014).
Conclusions: Smaller, guide-wire-inserted chest tubes cause substantially less pain than blunt-dissection-inserted larger tubes, without
any impairment in clinical outcome in the treatment of pleural infection. These results suggest that smaller size tubes may
be the initial treatment of choice for pleural infection, and randomized studies are now required.
Trial registration: MIST1 trial ISRCTN number: 39138989.
Concerns have been raised in recent years regarding co-selection for antibiotic resistance among bacteria exposed to biocides used as disinfectants, antiseptics and preservatives, and to heavy metals ...(particularly copper and zinc) used as growth promoters and therapeutic agents for some livestock species. There is indeed experimental and observational evidence that exposure to these non-antibiotic antimicrobial agents can induce or select for bacterial adaptations that result in decreased susceptibility to one or more antibiotics. This may occur via cellular mechanisms that are protective across multiple classes of antimicrobial agents or by selection of genetic determinants for resistance to non-antibiotic agents that are linked to genes for antibiotic resistance. There may also be relevant effects of these antimicrobial agents on bacterial community structure and via non-specific mechanisms such as mobilization of genetic elements or mutagenesis. Notably, some co-selective adaptations have adverse effects on fitness in the absence of a continued selective pressure. The present review examines the evidence for the significance of these phenomena, particularly in respect of bacterial zoonotic agents that commonly occur in livestock and that may be transmitted, directly or via the food chain, to human populations.
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